Although efficacies and proportions of tympanoplasty performed via endoscopic ear surgery (EES) have gradually introduced, it remains unclear whether total EES is a good alternative to microscopic ear surgery (MES). Herein, we aimed to compare therapeutic effects of EES and MES in patients receiving tympanoplasty or myringoplasty. A search of MEDLINE, PubMed, and Embase databases was conducted to compare the efficacies of EES and MES. Two investigators independently reviewed all studies and extracted data with a standardized form. We assessed risk of bias and calculated pooled odds ratio (OR) estimates with a 95% confidence interval (CI). Thirteen studies (607 EES patients and 678 MES patients) met inclusion criteria for quantitative meta-analysis. In pooled analysis, those who undergo EES have 0.99 times the OR of graft success compared to those with MES (95% CI, 0.84 to 1.16; P=0.894). In qualitative analysis, comparable hearing improvement was observed between the two groups, despite inconsistent audiometric evaluation. The air-bone gaps (ABGs) improved 2.02 dB less in EES than in MES (mean difference of improvements of ABGs, 2.02; 95% CI, –3.84 to –0.20; P=0.029); however, substantial heterogeneity and publication bias limited the integrity of this analysis. Further, EES significantly decreased canalplasty rate, wound complications, and operation time, compared to MES. Moreover, patients receiving EES reported higher cosmetic satisfaction than patients receiving MES. EES can be a good alternative to MES in terms of comparable graft success rate and hearing outcomes in patients receiving tympanoplasty or myringoplasty. Moreover, EES was less invasive, resulting in higher cosmetic satisfaction, reduced morbidity, and shorter operation time. Our results may affect decision-making and outcome prediction in cases of EES; however, confirmation is needed to clarify potential bias.
Bias (Epidemiology) ; Ear ; Endoscopes ; Hearing ; Humans ; Myringoplasty ; Odds Ratio ; Population Characteristics ; Publication Bias ; Research Personnel ; Therapeutic Uses ; Transplants ; Tympanoplasty ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate how fibrinogen-based collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP). SUBJECTS AND METHODS: Between August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty. RESULTS: The TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative air-bone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent. CONCLUSIONS: FCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.
Ambulatory Care Facilities ; Collagen* ; Facial Paralysis ; Hearing ; Hearing Loss, Conductive ; Hospitalization ; Humans ; Myringoplasty* ; Otolaryngology ; Paralysis ; Recurrence ; Thymidine Monophosphate ; Transplants* ; Tympanic Membrane Perforation* ; Tympanic Membrane* ; Tympanoplasty

OBJECTIVES: To evaluate endoscopic push-through technique cartilage myringoplasty results. METHODS: This prospective study was performed on patients with anterior tympanic membrane perforations and endoscopic push-through technique cartilage myringoplasty was performed between 2011 and 2013. The patients who did not have any cholesteatoma or otorrhea in the previous 3 months, and had an air bone gap < or =25 dB in their preoperative audiograms were included in the study. They were followed up with endoscopic examination and audiograms at 2nd, 6th, 12th, and 24th postoperative months. Pure tone averages were calculated at 0.5, 1, 2, and 4 kHz frequencies. RESULTS: Of 32 patients, 19 were females and 13 were males. The mean age was 40.3 years (range, 16 to 62 years), and the mean follow-up period was 12.4 months (range, 6 to 24 months). Graft success rate was 87.5% in this study. Preoperative mean air conduction hearing threshold was 25.9 dB, and the mean air-bone gap was 11.9 dB while these values improved to 19.5 dB and 5.3 dB respectively in the postoperative period. The mean hearing gain was 6.4 dB. The analysis of preoperative and postoperative mean air conduction thresholds and air bone gap values of the patients revealed statistically significant differences. CONCLUSION: Underlay cartilage myringoplasty with endoscopic push-through technique in anterior quadrant tympanic membrane perforations is an effective, minimally invasive and feasible method.
Cartilage* ; Cholesteatoma ; Endoscopy ; Female ; Follow-Up Studies ; Hearing ; Humans ; Male ; Myringoplasty* ; Postoperative Period ; Prospective Studies ; Transplants ; Tympanic Membrane*

OBJECTIVES: Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients. METHODS: Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location. RESULTS: Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924). CONCLUSION: The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid.
Audiometry ; Ear, Middle ; Hearing Loss, Conductive* ; Humans ; Mastoid ; Myringoplasty ; Tympanic Membrane ; Tympanic Membrane Perforation* ; Tympanoplasty

Tympanic membrane (TM) perforation is common. Acute persistent or chronic TM perforations require surgical interventions such as myringoplasty or tympanoplasty. Current strategies of tissue engineering are focused on the regeneration of TM perforation instead of surgical interventions. To regenerate TM tissue or restore acoustic-mechanical property, bioscaffold or growth factors are necessary that will act as a temporary matrix for cell proliferation and extracellular matrix deposition, with subsequent ingrowths. In recent years, various scaffolds, biomolecules have been used for TM tissue engineering. Cells in combination with supportive scaffolds have rarely reported. TM regeneration by tissue engineering approach may be considered the greatest advances in otology. This review examines the current evidence for their use and the limitations of knowledge.
Cell Proliferation ; Extracellular Matrix ; Intercellular Signaling Peptides and Proteins ; Myringoplasty ; Otolaryngology ; Regeneration* ; Tissue Engineering* ; Tympanic Membrane* ; Tympanoplasty

BACKGROUND AND OBJECTIVES: There is no consensus on the prognostic factors regarding pos-toperative recurrence after myringoplasty. In this study, we investigated the preoperative clinical findings and postoperative results after primary myringoplasty and compared them with those of revision myringoplasty. SUBJECTS AND METHOD: Computerized database of 861 clinical records of last 20 years were analyzed retrospectively for the subjects who underwent myringoplasty at the Department of Otolaryngology, University of Korea. All the surgeries were done under general or local anesthesia by senior surgeons. Primary and revision cases of myringoplasty or type 1 tympanoplasty followed up at least for longer than 3 months were only included in the study. Those other cases of tympanoplasty types, concomitant ossiculoplasty and/or mastoidectomy, or those with the presence of cholesteatoma and those that required repair during exploratory tympanotomy were excluded. RESULTS: 535 primary and 101 revision cases have met our inclusion criteria. Overall, in this study, the failure rates of primary and revision myringoplasty were 11.02% and 5.94%, respectively. Significantly different among the prognostic factors were such as sex, age, anesthesia, surgical approach, the presence of otorreha, size of eardrum perforation, external auditory canal narrowing, valsalva test, degree of pneumatization, graft materials, tympanoplasty type, previous mastoidectomy, the presence of bilateral otitis media influencing on myringoplasty revision, and the presence of otorrhea and sclerotic type of mastoid pneumatization. CONCLUSION: Among various prognostic factors of myringoplasty, poor prognostic factors were preoperative otorrhea and poor pneumatization.
Anesthesia ; Anesthesia, Local ; Cholesteatoma ; Consensus ; Ear Canal ; Korea ; Mastoid ; Myringoplasty* ; Otitis Media ; Otolaryngology ; Recurrence ; Retrospective Studies ; Transplants ; Tympanic Membrane Perforation ; Tympanoplasty

OBJECTIVE: To evaluate effectiveness of endoscopic tragus cartilage-perichondrium in the treatment of large tympanic membrane perforations. METHOD: Patients with large tympanic membrane perfortations who had underwent cartilage-perichondrium myringoplasty were retrospectively retrieved from our department. Those with a follow-up of equal to or greater than 12 months after surgery were included in the study. Hearing test results were reported using a four-frequency air conduction and bone-air conduction gap. Patients were labeled as treatment success if the tympanic membrane was intact without lateralization or anterior blunting after surgery. RESULT: Of the 35 patients with large tympanic membrane perforations treated by endoscopic tragus cartilage-perichondrium, 33 (94.3%) were treatment success. There was no graft lateralization, anterior blunting, neocholesteatoma, and sensorineural hearing loss in these patients after surgery. The air conduction and bone-air conduction gap before surgery in the study cohort were (43.8 ± 5.7) dB and (28.5 ± 3.1) dB, respectively. Postoperative air conduction and bone-air conduction gap of the cohort were (31.4 ± 6.4) dB HL and (16.2 ± 4.1) dB, respectively. The postoperative air conduction and bone-air conduction gap decreased significantly after surgery (P < 0.01). Overall postoperative air-bone gap in 27 of the 35 patients (77%) were less than 20 dB after surgery. CONCLUSION Endoscopic cartilage-perichondrium myringoplasty is an effective procedure in the treatment of large tympanic membrane perforations.
Bone Conduction ; Cartilage ; Cohort Studies ; Ear Auricle ; Endoscopy ; Hearing ; Hearing Tests ; Humans ; Myringoplasty ; Postoperative Period ; Retrospective Studies ; Treatment Outcome ; Tympanic Membrane ; Tympanic Membrane Perforation ; surgery ; Tympanoplasty

OBJECTIVE: To explore the effect of the canalplasty for inlay myringoplasty. METHOD: A retrospective study was performed on 125 patients (130 ears) who underwent canalplasty and myringoplasty for the treatment of the chronic otitis media. The postauricular incisions was made, then the separation of the flap of posterior canal skin and the tympanic membrane epithelium, mill addition to part of the canal bone of the top, bottom, behind. Lift forward on the anterior canal skin, until the formation of the external auditory canal skin tube. Metal sheets was used to protect the skin tube, mill addition to the prominent bone of the anterior canal, reveal the tympanic anulus fully. Explore the ossicular chain activities, fascia covering the canal and fiber layer surface of the drum remnant was used as an inlay graft, and the canal skin was replaced. The canal was filled with hemostatic gauze and hemostatic sponge. Stitches a week after surgery. Removal of filling material in the external auditory canal two weeks after surgery, and re-filling with sterile gauze until healed. RESULT: All 125 patients had successful grafts with 100% survival rate and healed in stage I. Average improvement in air-bone gap for all patients was 8.9 dB. Stenosis of the external auditory canal and lateralization of the grafted drum did not occur. Follow-up was conducted for 1-3 years. Three ears had reperforation and eight ears had late atelectasis. Fifteen ears had myringitis and healed by halometasone cream. CONCLUSION Canalplasty is an important surgical procedure on inlay myringoplasty. It can make the narrow and curved canal to large, eliminate the prominent bone of the anterior wall, expose the perforation edge fully, further facilitate the survival of the graft and post-operative care.
Adolescent ; Adult ; Aged ; Ear, External ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myringoplasty ; methods ; Otitis Media, Suppurative ; surgery ; Otologic Surgical Procedures ; Retrospective Studies ; Young Adult

PURPOSE: This prospective study evaluated the effects of continuous sedation using midazolam, with or without remifentanil, on postoperative nausea and vomiting (PONV) in patients undergoing myringoplasty. MATERIALS AND METHODS: Sixty patients undergoing myringoplasty were sedated with midazolam in the presence of remifentanil (group MR), or after saline injection instead of remifentanil (group M). RESULTS: Three patients (10%) in group M complained of nausea; two vomited. Four patients (13%) in group MR complained of nausea and vomited within 24 h after surgery. Rescue drugs were given to the six patients who vomited. No significant difference was detected between the two groups regarding the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs. CONCLUSION: Midazolam-based continuous sedation can reduce PONV after myringoplasty. Compared with midazolam alone, midazolam with remifentanil produced no difference in the incidence or severity of nausea, incidence of vomiting, or need for rescue drugs.
Humans ; Incidence ; Midazolam* ; Myringoplasty* ; Nausea ; Postoperative Nausea and Vomiting* ; Prospective Studies ; Vomiting

Intratympanic membrane congenital cholesteatoma (ITMCC) is extremely rare in patients without previous trauma or surgery of the ear. There are multiple theories to the pathogenesis of middle ear congenital cholesteatoma but none are applicable for ITMCC. When the size of ITMCC is small, there are usually no ear symptoms. However, surgery is needed early, as in any other type of cholesteatoma, because early treatment before middle ear involvement enables enucleation without the need for other procedures such as myringoplasty. We report an incidental finding of a small pearl at the umbo in a 2-year-old boy. The cholesteatoma involved only the outer epidermic layer of the tympanic membrane (TM). A transcanal approach was performed and the cholesteatoma was enucleated from TM.
Cholesteatoma ; Ear ; Ear, Middle ; Humans ; Incidental Findings ; Membranes ; Myringoplasty ; Preschool Child ; Tympanic Membrane